Opioid Addiction Bureau of Workers Compensation PA Training
Opioid Addiction Bureau of Workers’ Compensation PA Training for Health & Safety (PATHS) PPT-151 -01 1
Topics • Opioids – What They Are • Commonly Prescribed Opioids • How Addiction Can Begin • Definition of Addiction • Six Signs of Addiction/Abuse • What Employers Can Do • Naloxone/Narcan • What Physicians Can Do PPT-151 -01 2
What are Opioids* • Medications that relieve pain. • They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus. • Medications that fall within this class include hydrocodone (e. g. , Vicodin), oxycodone (e. g. , Oxy. Contin, Percocet), morphine (e. g. , Kadian, Avinza), codeine, and related drugs. PPT-151 -01 3
Commonly Prescribed Opioids • Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injuryrelated pain. • Morphine is often used before and after surgical procedures to alleviate severe pain. • Codeine, on the other hand, is often prescribed for mild pain. • In addition to their pain relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil) for examplecan be used to relieve coughs and severe diarrhea. PPT-151 -01 4
What Can Happen • If an employee is injured at work and is prescribed an opioid they may become dependent upon the medication to manage their pain. • If the physician determines their pain is no longer at the level where opioids are necessary they may discontinue prescribing them. • If an employee has a dependency problem they can turn to other methods to find relief for their real or imagined pain. • This can lead to the use of heroin or other similar drugs. PPT-151 -01 5
Addiction • Addiction is a disease that affects a person’s brain and behavior. • When a person is given a prescription pain reliever they may feel if one pill “calms down” the pain two may stop it completely. • When drugs are misused, their pleasurable effect eventually makes a person want to keep using them. PPT-151 -01 6
Addiction • Over time, a person’s brain actually changes in certain ways so that they develop a powerful urge to use the drug. • If the doctor stops issuing the drug the person now needs to find a source to deal with the supposed pain whether real or imagined. PPT-151 -01 One year drug free 7
Six Signs of Addiction • Appearance: usually well-kempt employee may appear disheveled as drug addiction becomes worse. • The following physical signs from Helpguide. org may indicate drug abuse: ü Bloodshot eyes or dilated or constricted pupils. ü Change in appetite: weight loss or gain. ü Unusual smells on breath, body, or clothing. ü Tremors, slurred speech, or impaired coordination. ü Needle marks with heroin abuse. PPT-151 -01 8
Substance Use in the Workforce Among full-time workers, age 18+: One in 12 individuals (8%) report past month use of illicit substances. Of adult binge drinkers or heavy drinkers, 79% are employed either full or part time. Percentage of Current Drug Use Based on Employment Status Not in the Labor Force 21% Unemployed 13% Full time 47% A total of 66% of illicit drug users are employed full or part time Part time 19% PPT-151 -01 9
Substance Use in the Workforce Turnover and Absenteeism • Those with illicit drug use were more than twice as likely than those without current drug use to have worked for more than 3 employers in the past year (12. 3% vs. 5. 1%) • Full time employees who were current illicit drug users were more likely to miss two or more workdays in the past month due to illness and injury (16. 4% vs. 11. 0%) • Full time employees who were current illicit drug users were more likely to skip one or more days of work in the past month (16. 3% vs. 8. 2%) PPT-151 -01 10
Impact of Substance Use • Why care about drug and alcohol use in the workplace? o Individuals abusing substances are more likely to: ü To change jobs frequently ü To be late to or absent from work ü To be less productive employees ü To be involved in a workplace accident ü To file a workers’ compensation claim • Why care about drug and alcohol treatment? ü 1 in 4 people have substance use disorder in their families ü 1 in 4 people with substance use disorder will die as a result PPT-151 -01 11
Tardiness or Sleeping on Job • Opioids, like alcohol, are a depressant-an employee who is abusing prescription drugs or heroin may fall asleep while on the job. • Even a single large dose can cause severe respiratory depression and death according to the National Institute on Drug Abuse. PPT-151 -01 12
Theft Whether it’s stealing computers, money or scrap, an increase in theft could be an indication of a drug addiction problem within the workplace. PPT-151 -01 13
Poor Decision Making • A slower reaction time can lead an employee who has an addiction problem to make a poor decision leading to their or a co-worker’s injury. • The issue involves science. • Drugs affect the pain center of the brain as well as impact the frontal cortex where risks and benefits are determined and decisions made. PPT-151 -01 14
Inability to Work with Others/Complete Tasks • Employee’s ability to think and make competent decisions is compromised. • Could have difficulty following directions. • May have mood swings that affect working with others. • Could affect overall morale. PPT-151 -01 15
What Employers Can Do • Educate employees about responsible prescription opioid use: ◦ Used responsibly, opioids can be an effective tool to mask acute pain ◦ Workers need to understand the potency of these drugs, how they work, how they interact with other drugs and how they can become addictive. • Understand risk factors of opioid abuse. ◦ Understanding and communicating the risk factors for opioid abuse is vital for prevention. ◦ Employees should learn about doctor shopping, physician dispensing and other risk factors supported by evidence. PPT-151 -01 16
What Employers Can Do • Provide support and safe return to work to injured employees: ◦ For injured workers it is important to provide strong social support from fellow workers, especially the immediate supervisor and management, to help the worker safely return to work. ◦ The most important person in returning an employee back to work is the immediate supervisor. PPT-151 -01 17
What Employers Can Do Provide support and safe return to work to injured employees: § When implemented, a program of key steps can result in fewer lost days and decreased wage loss for employees. § Will redirect the focus from the injured worker’s disability to promoting work ability, leading to greater employee morale. PPT-151 -01 18
What Employers Can Do • Communicate treatment options: o If treatment is necessary, it is important to educate o o o the worker on options, including counseling and pharmaceutical treatment. Substance Use Disorder is a brain disease that can be treated effectively. Treatment options include behavior modification and may include pharmacological interventions. Behavioral treatments help the addict deal with cravings, avoid situations where drugs are present and strengthen social support. Pharmacological interventions include the use of addiction medications. The specific approach is individualized based on clinical need. PPT-151 -01 19
What Employers Can Do • Ask the right questions. ◦ Very important to ask yourself and your physician questions. ◦ The American College of Occupational and Environmental Medicine (ACOEM) suggests a number of guidelines. PPT-151 -01 20
What Employers Can Do • Implement Drug-Free Workplace Policies o Good polices generally include: • A written policy • Employee education • Supervisor training • An employee assistance program (EAP) • Drug testing • Other elements: • A minimum of 2 hours of training for all employees • Additional training for working parents • Drug testing by a certified institution • A continuing drug and alcohol abuse prevention program PPT-151 -01 21
What Employers Can Do • Implement Drug-Free Workplace Policies o Benefits of these policies: § To comply with laws or regulations § To qualify for insurance discounts, rebates, and other incentives § To prevent associated problems (e. g. , absenteeism, accidents, injuries, productivity loss) § To respond to an incident or pattern of substance abuse § To express support for the majority of employees who do not abuse alcohol or other drugs § To invest in worker health, safety, and productivity § To market drug-free workers and services PPT-151 -01 22
Naloxone • Many police departments and emergency response agencies now have the drug Naloxone which is also called Narcan. • This drug has been called “The Second Chance Drug” and is used as an antidote that reverses an opioid overdose. • It works by neutralizing the opioids in your system and helping you breathe again. • Naloxone only works if a person has opioids in their system; the medication doesn't work on other drugs. PPT-151 -01 23
What Doctors Can Do • The Centers for Disease Control and Prevention (CDC) recommends that physicians do not prescribe opioids for patients in chronic pain. • The CDC recommends that physicians use alternative/safer non-opioid pain relievers when considering prescribing for patients in pain. • The CDC also recommends that physicians have a urine test conducted before opioid therapy and starting with the lowest dose possible. • In addition, the CDC recommends prescribing immediate-release as opposed to longer-acting opioids, and limiting treatment for acute pain to usually no more than 7 days. PPT-151 -01 24
Substance Use Disorder An individual with substance use disorder is protected by the ADA as having a disability. However, this does not provide protection from engagement in illegal behaviors such as heroin use. PPT-151 -01 25
Summary • Employers should be aware that there is an opioid epidemic within the U. S. and that any individual or organization can be affected. • Supervisors and Managers should be aware of the signs and symptoms of addiction/abuse. • Employers should have “no tolerance” drug use policies within the workplace and should be willing to enforce those policies. • Employees with an addiction/abuse problem should be encouraged to seek help through Employee Assistance Programs and/or counseling. PPT-151 -01 26
Contact Information Health & Safety Training Specialists 1171 South Cameron Street, Room 324 Harrisburg, PA 17104 -2501 (717) 772 -1635 RA-LI-BWC-PATHS@pa. gov Like us on Facebook! - https: //www. facebook. com/BWCPATHS PPT-151 -01 19
Questions PPT-151 -01 28
Bibliography EHS Today, “Six Signs of Employee Opioid Abuse, ” July 21, 2016 Physical effects: Helpguide. org National Institute on Drug Abuse Construction Executive, “Five Ways to Avoid Opioid Abuse, ” May 5, 2016 PPT-151 -01 29
Bibliography The American College of Occupational and Environmental Medicine (ACOEM) “Guidelines for the Chronic Use of Opioids” at https: //www. nhms. org/sites/default/files/Pdfs/ACOE M%202011 -Chronic%20 Pain%20 Opioid%20. pdf Prescription-Nation-2016 -American-Drug. Epidemic. pdf PA Department of Drug and Alcohol Programs http: //www. ddap. pa. gov/pages/default. aspx PPT-151 -01 30
Related Programs The following programs available from us may aid you in providing more in-depth training on the topic of “Opioid Addiction. ” • Dealing with Angry People • Drug & Alcohol Awareness for Supervisors • Drug & Alcohol Awareness for Employees If not found on our website www. dli. state. pa. us/PATHS email us for a copy. PPT-151 -01 31
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